Haddad F S, Pense S, Christenson S
Section of Urology, VAMC, Phoenix, Arizona, USA.
J Med Liban. 1994;42(3):149-54.
Spontaneous intraperitoneal rupture of the bladder (also called unsuspected, idiopathic, or non-traumatic rupture of the bladder) is a well defined but rare condition which has not been universally recognized in the past. We are reporting four cases and emphasizing its clinical picture so it might be better recognized and diagnosed early on in the process, and so that its management be planned appropriately in order to reduce its morbidity and its mortality. A review of the literature is provided to help achieve this end. Spontaneous intraperitoneal vesical rupture is almost always a surprise at laparotomy. A high degree of suspicion, the finding of urea in the ascitic fluid, and cystography may help in the diagnosis. Symptoms include abdominal pain, difficulty in micturition, hematuria and renal failure with elevation of the blood urea and acidosis. The etiology seems to be varied and somehow confused. We discuss four groups of etiological factors: dulled sensorium, weakening of the bladder wall, increased intra-vesical pressure (with or without bladder outlet obstruction) and vascular lesions (radiotherapy, arterial embolism and vesical infarction); and we try to discern common denominators for these four groups of etiological factors: an increase in intravesical pressure along with a weakening of the bladder wall. Finally the new concept of vesical infarction following ischemia due to overdistention of the bladder is introduced and discussed.
膀胱自发性腹膜内破裂（也称为隐匿性、特发性或非创伤性膀胱破裂）是一种已明确但罕见的病症，过去尚未得到普遍认识。我们报告了4例病例，并着重阐述其临床表现，以便在病程早期能更好地识别和诊断，从而合理规划治疗方案，降低其发病率和死亡率。为达此目的，本文提供了文献综述。膀胱自发性腹膜内破裂在剖腹手术中几乎总是令人意外。高度怀疑、腹水中发现尿素以及膀胱造影有助于诊断。症状包括腹痛、排尿困难、血尿和肾衰竭，伴有血尿素升高和酸中毒。病因似乎多种多样且有些复杂。我们讨论了四组病因：感觉迟钝、膀胱壁薄弱、膀胱内压升高（伴有或不伴有膀胱出口梗阻）以及血管病变（放疗、动脉栓塞和膀胱梗死）；并试图找出这四组病因的共同特征：膀胱内压升高同时膀胱壁薄弱。最后引入并讨论了膀胱过度扩张导致缺血后膀胱梗死的新概念。
